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Their View: Protect consumers in the healthcare exchange

By Rep. Mimi Stewart / For the Sun-News

Posted:
03/10/2013 01:00:00 AM MST

Our governor and state Legislature are right now debating how insurance companies are going to sell you healthcare insurance.

Under the Affordable Care Act, everyone must have healthcare insurance and each state is required to set up a system to facilitate the selection and purchase of healthcare insurance policies. These systems are called exchanges. Some states have designed their exchange to simply make it easier for insurance companies to sell their policies. Other states have designed their exchange to assist purchasers in getting a good policy that works well for their needs and their pocketbooks. In New Mexico, we are considering several models, but none of them are very far from a "help insurance companies sell" model. And only one of them, House Bill 168, offers any consumer protections.

Why would consumers need protections in the market for healthcare insurance? The best approach, say the insurance companies, is to allow the free market to work. They say competition will result in only good insurance policies being purchased through the exchange. What malarkey! The healthcare insurance market under the Affordable Care Act will not be a free market. Everyone is required to buy healthcare insurance so the demand is not set by the marketplace.

The consumers are New Mexican families struggling to make ends meet. The businesses are giant out-of-state corporations with local office fronts.

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This is the industry that brought you "pre-existing conditions," the right to terminate your coverage if your illness begins costing them too much, the right to raise premiums every year while earning record profits, and many other horrible policies that have bankrupted so many Americans. One reason for consumer protections: history proves that many insurance companies will take abusive advantage of consumers.

Another reason New Mexicans could use consumer protections in the Exchange is because insurance is a complex product. Matching one's needs and resources with the right insurance product is a very challenging task. How many of us have succeeded in truly understanding our health insurance policy? Would the average consumer be able to hold their own in a business transaction for policies written by insurance industry attorneys who will have exploited every loophole, exception and weakness in the law?

There are four exchange models being discussed in the Legislature. Three of these offer little or no consumer protections.

The fourth offers a few. House Bill 168 allows only one insurance carrier on the board of the exchange to avoid having the fox ruling the hen house. The other bills allow as many as five insurance companies on the board. House Bill 168 allows the board of the exchange to set minimum standards for the insurance policies offered through the exchange. The bills backed by insurance companies force the exchange to only offer policies that meet minimal requirements of the federal government. House Bill 168 establishes a "navigator" program for both the Exchange and Medicaid that will reach out to New Mexicans required to buy healthcare insurance and give them a little help in applying for a policy. HB 168 also has the Exchange and Medicaid department work together to help people who transition from Medicaid to private insurance as their income changes.

We in the Legislature have the responsibility to put New Mexicans first. House Bill 168 offers consumer protections that fit well within the exchange structure required by federal law. We should prioritize for New Mexicans, not insurance companies. Our healthcare exchange should not be stacked with corporate interests. These are not government interventions in the free market, this is common sense. There is no free market when consumers are required to purchase a product. House Bill 168 offers protections to New Mexican families who will soon be required to buy, some for the first time ever, a complex product from large corporations used to having their way.

Rep. Mimi Stewart (D-Bernaillo-21) is the chairwoman of the House Education Committee serving in her 19th year in the New Mexico Legislature. She is a retired educator who taught in public schools for 30 years.

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